Simvastatin is an antilipemic agent that decreases low-density lipoprotein cholesterol levels by inhibiting hydroxy-methylglutaryl coenzyme A reductase. Statins have an excellent safety profile (1). However, reports have described a lupus-like hypersensitivity reaction with late, insidious onset (2-4). Symptoms include polymyalgia, elevated erythrocyte sedimentation rate (ESR), positivity for antinuclear antibodies, and potentially life-threatening pneumonitis. To highlight the diversity of this drug-induced hypersensitivity, we report a case in which the patient presented with dysphasia.

A 74-year-old man with coronary artery disease and hypertension presented with sudden onset of dysphasia. He was initially thought to have a viral illness, but symptoms progressed over weeks to the point where he was able to swallow only liquids. His hematocrit decreased from an initial value of 0.44 to 0.28 with no reticulocyte response or evidence of hemolysis. Eosinophilia (eosinophils, 38%), ESR of 100 mm/h, and lactate dehydrogenase level of 320 U/L were noted. Results of endoscopy and esophageal peristalsis studies were normal. Computed tomography showed borderline splenomegaly with mediastinal and retroperitoneal adenopathy. Bone marrow biopsy revealed only increased eosinophils. The rheumatoid factor level was normal, and the patient was strongly positive for antinuclear antibodies.